The bleeding time: its potential utility among patients receiving thrombolytic therapy.
The BT as a test of hemostatic function was first described 80 years ago. It has generally been considered a primitive and tedious test. Improvements in technique and standardization have increased the BT's reliability and led to its consideration as a preoperative screening measure. Current use has not been widespread, however, except for patients undergoing neurosurgery and organ biopsy. Recently, though, there has been a renewed interest in the BT for patients receiving thrombolytic therapy because levels of fibrinogen and fibrin(ogen) degradation products have been only weak predictors of hemorrhagic complications. The rationale for using the BT in this setting is that thrombolysis appears to impair platelet function, either through depletion of platelet granules or through direct proteolytic actions on platelets. Further research will determine whether these platelet effects are manifest as BT prolongation; whether increased BT will correlate with hemorrhagic complications; and, finally, whether patients who fail to achieve clot lysis or those at risk for bleeding can be identified prospectively.
Hirsch
D R
DR
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Goldhaber
S Z
SZ
D001760:Bleeding Time; D001792:Blood Platelets / Q000502:physiology; D001808:Blood Vessels / Q000502:physiology; D005544:Forecasting; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D010979:Platelet Function Tests; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D014481:United States